Radiology

The choice and timing of radiographic studies depends on the clinical stability of the patient. Management of head, chest, and abdominal trauma takes precedence over facial imaging. In the critically injured, diagnostic imaging of the face, including computed tomography (CT), may be deferred for days, until the patient's condition has stabilized.

It is not always clear which patients require facial imaging. In one study, physical examination alone detected 90 percent of clinically significant fractures. 11 However, management was altered in 17 percent of patients based on either CT or plain films.11 CT scan is not always required before surgical repair. Some authorities consider scans expensive, time consuming, and labor intensive, adding little information to that gained from physical examination and plain films.

Because immediate surgical intervention is rarely indicated for patients with facial trauma, some argue that most x-rays or CTs may be deferred in the ED. If adequate follow-up is available, a facial surgeon could determine the need for imaging studies at the time of outpatient consultation. On the other hand, because many patients with facial fractures are noncompliant when it comes to follow-up, definitive ED diagnosis of an injury theoretically prompts patients to keep the consultative appointment.

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